title: Risk factors for colonoscopic perforation: a population-based study of 80118 cases.
abstract: OBJECTIVE
  To assess the incidence and risk factors associated with colonic perforation due to colonoscopy.
  
  
  METHODS
  This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if they were 18 years and older and had an inpatient or outpatient colonoscopy procedure code in any facility within the Geisinger Health System during the period from January 1, 2002 to August 25, 2010. Data are presented as median and inter-quartile range, for continuous variables, and as frequency and percentage for categorical variables. Baseline comparisons across those with and without a perforation were made using the two-sample t-test and Pearson's χ² test, as appropriate.
  
  
  RESULTS
  A total of 50 perforations were diagnosed out of 80118 colonoscopies, which corresponded to an incidence of 0.06% (95%CI: 0.05-0.08) or a rate of 6.2 per 10000 colonoscopies. All possible risk factors associated with colonic perforation with a P-value < 0.1 were checked for inclusion in a multivariable log-binomial regression model predicting 7-d colonic perforation. The final model resulted in the following risk factors which were significantly associated with risk of colonic perforation: age, gender, body mass index, albumin level, intensive care unit (ICU) patients, inpatient setting, and abdominal pain and Crohn's disease as indications for colonoscopy.
  
  
  CONCLUSIONS
  The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn's disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy.
authors.affiliation: Department of Gastroenterology, Geisinger Medical Center, Danville, PA 17822, USA. sthamdani@geisinger.edu
authors.forename: Uzair
authors.initials: U
authors.lastname: Hamdani
authors.forename: Raza
authors.initials: R
authors.lastname: Naeem
authors.forename: Fyeza
authors.initials: F
authors.lastname: Haider
authors.forename: Pardeep
authors.initials: P
authors.lastname: Bansal
authors.forename: Michael
authors.initials: M
authors.lastname: Komar
authors.forename: David L
authors.initials: DL
authors.lastname: Diehl
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003106:Colon / Q000293:injuries*; D003113:Colonoscopy / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: Colon cancer; Colonoscopic perforation; Endosocopy